OP0179 CHARACTERISTICS AND OUTCOMES OF SARS-CoV-2 BREAKTHROUGH INFECTIONS AMONG DOUBLE AND TRIPLE VACCINATED PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES
Authors: R. Hasseli, B. F. Hoyer, H. M. Lorenz, A. Pfeil, A. Regierer, J. Richter, T. Schmeiser, A. Strangfeld, A. Krause, R. Voll, H. Schulze-Koops, U. Müller-Ladner, C. Specker
Journal: Annals of the Rheumatic Diseases (2022)

Background SARS-CoV-2 vaccines offer the most effective way to reduce the risk of severe COVID-19. Recent data indicate sufficient immune response after vaccination in most patients with inflammatory rheumatic diseases (IRD) on immunomodulatory treatments. Objectives To investigate the clinical profile of SARS-CoV-2 breakthrough infections among double and triple vaccinated patients with IRD. Methods Data from the German COVID-19-IRD registry, collected by treating rheumatologists between February 2021 and January 2022 were analysed. Patients double or triple vaccinated against COVID-19 ≥14 days prior to proven SARS-CoV-2 infection were identified, and type of IRD, vaccine, immunomodulation, comorbidities and outcome of the infection were compared with 737 unvaccinated IRD-patients with COVID-19. Results In total, 271 cases of breakthrough infections were reported, 250 patients (91%) had received two doses of vaccines, 21 (9%) patients three. More than 70% of the patients received Pfizer/Biontech vaccine for the first, second and third vaccination. The median time from second/third vaccine dose to infection was 148 days (range 14-302) days. Most of the patients were diagnosed with inflammatory joint diseases (Table 1). Most of the patients were treated with methotrexate (Table 1). The use of Januskinase inhibitors(i) was more frequently reported in double vaccinated patients (10.4% vs 4.8%), whereas tumor necrosis (TNF)i were reported more often in triple vaccinated patients (33.3% vs. 22.8). Hospitalisation rate was higher in unvaccinated IRD-patients than in vaccinated ones, while fatality rate was similar in unvaccinated and double vaccinated patients. Although the rate of comorbidities and median age were higher in triple-vaccinated patients, infected patients showed a lower rate of hospitalisation, neither COVID-19 related complications, nor the need of oxygen treatment or death. Table 1. Profile of vaccinated IRD patients unvaccinated 2 nd vaccination 3 rd vaccination Number (737) % Number (250) % Number (21) % Age 56 (18-93) 57 (22-90) 63 (35-88) Female 478 64.9 158 63.2 13 61.9 BMI 26.8 (17-53) 26.7 (17-55) 25.4 (18-41) Inflammatory rheumatic disease (multiple selections possible) Inflammatory joint diseases 561 75.9 186 74.4 16 76.2 Connective tissue diseases 101 12.8 30 12 2 9.6 Vasculitis 71 9.6 22 8.8 3 14.3 Other IRD 63 8.5 29 11.6 1 4.8 Immunomodulation (multiple selections possible) Glucocorticoid 212 28.8 67 26.8 5 23.8 Methotrexate 270 36.6 90 36 8 38.1 Azathioprine 19 2.6 7 2.8 / / Cyclosporine 3 0.4 1 0.4 / / Leflunomide 50 6.8 7 2.8 / / Hydroxychloroquine 79 10.7 23 9.2 1 4.8 Sulfasalazine 20 2.7 9 3.6 / / JAKi 54 7.3 26 10.4 1 4.8 TNFi 158 21.4 57 22.8 7 33.3 Abatacept 9 1.2 3 1.2 / / Rituximab 21 2.8 11 4.4 1 4.8 Other biologics 59 7.9 32 12.8 2 9.6 Mycophenolate 15 2 4 1.6 / / Immunoglobulines 2 0.3 1 0.4 / / Apremilast 4 0.5 / / / / Cyclophosphamide 1 0.1 1 0.4 / / No immunomodulation 74 10 22 8.8 1 4.8 No/low disease activity 625 84.8 223 89.2 18 85.7 Moderate/high disease activity 102 13.8 27 10.8 3 14.3 Comorbidities Cardiovascular diseases 329 44.6 130 52 13 61.9 Diabetes mellitus 76 10.3 25 10 / / Osteoporosis 43 5.8 21 8.4 2 9.5 Chronic renal failure 40 5.4 16 6.4 4 19 Cancer/history of cancer 15 2.0 10 4 3 14.3 COPD 25 3.4 10 4 / / ILD 16 2.2 7 2.8 / / Bronchial asthma 34 4.6 16 6.4 / / Pregnancy 7 0.9 1 0.4 1 4.8 No comorbidity 254 34.5 97 38.8 5 23.8 Complications due to COVID-19 Hospitalisation 135 18.3 29 11.6 2 9.5 Oxygen treatment 114 15.5 24 9.6 / / Invasive ventilation 25 3.4 9 3.6 / / Death 16 2.2 7 2.8 / / Conclusion In this cohort of triple-vaccinated IRD patients no fatal courses and no COVID-19 related complications were reported, although median age and rate of comorbidities were higher compared to double-vaccinated and unvaccinated patients. These results support the general recommendations to reduce the risk of severe COVID-19 disease by administering three doses of vaccine, especially in patients with older age, presence of comorbidities, and on immunomodulatory treatment. Disclosure of Interests None declared